CN107206200A

CN107206200A - Method for being ventilated under unknown exhalation traffic conditions

Info

Publication number: CN107206200A
Application number: CN201680005942.6A
Authority: CN
Inventors: N·F·董; G·桑切斯
Original assignee: Nellcor Puritan Bennett LLC
Current assignee: Nellcor Puritan Bennett LLC; Covidien LP
Priority date: 2015-01-20
Filing date: 2016-01-20
Publication date: 2017-09-26
Anticipated expiration: 2036-01-20
Also published as: EP3247436A1; WO2016118628A1; CN107206200B; US20160206837A1; EP3247436B1; US9925346B2

Abstract

The present invention provide it is a kind of be used for the method that lung ventilator is patient ventilation, it includes：The fixed base flow of conveying；With the lung ventilator be the patient ventilation during monitoring exhalation flow, exhalation pressure and exhalation aux. pressure, to determine monitoring exhalation flow, institute monitoring breathe out pressure and monitoring breathe out aux. pressure；At least monitor that exhalation flow detects the first trigger condition based on described；Detect first trigger condition in response to described and trigger air-breathing；It is determined that monitoring exhalation flow in the absence of described；And determined in response to described：At least stop utilizing first trigger condition based on the exhalation flow；Based on it is described monitor exhalation pressure and it is described monitor that exhalation aux. pressure estimates the exhalation flow, to determine estimated to breathe out flow；The second trigger condition is at least detected based on the estimated exhalation flow；And detect second trigger condition in response to described and trigger air-breathing during the ventilation.

Description

Method for being ventilated under unknown exhalation traffic conditions

The application is submitted on January 20th, 2016 as PCT International Patent Application, and it requires on January 20th, 2015 The priority of the U.S. Patent Application No. 14/600,261 of submission, the disclosure of the U.S. Patent application is quoted in full Mode be incorporated herein.

Background technology

Medical ventilator system is used to provide ventilation for patient and oxygenating is supported.Lung ventilator is generally included by conduit or pipe Conduit fluidly it is connected to the pressurised oxygen source of the gas of patient.Because each patient may require different ventilation strategies, therefore it can be directed to The specific needs customization lung ventilator of few patients.For example, some different lung ventilator patterns have been set up or have been set with each Plant to provide for patient under different situations and preferably ventilate, such as forced-ventilation pattern and assist-control ventilation pattern.

The content of the invention

The present invention describes the system and method for providing the novel ventilation for allowing patient to trigger or originate conveying breathing.This Outside, the present invention describes the system and method for the triggering ventilation in the unknown exhalation flow of lung ventilator or unreliable exhalation flow.

Partly, present invention description is a kind of is used for the method that lung ventilator is patient ventilation.Methods described is included：

The fixed base flow of conveying；

Monitoring exhalation flow, exhalation pressure and exhalation aux. pressure during being the patient ventilation with the lung ventilator, With determine institute monitoring exhalation flow, monitoring breathe out pressure and monitoring breathe out aux. pressure；

At least monitor that exhalation flow detects the first trigger condition based on described；

Detect first trigger condition in response to described and trigger air-breathing；

It is determined that monitoring exhalation flow in the absence of described；And determined in response to described：

At least stop utilizing first trigger condition based on the exhalation flow；

Based on it is described monitor exhalation pressure and it is described monitor that breathing out aux. pressure estimates the exhalation flow, with true Fixed estimated exhalation flow；

The second trigger condition is at least detected based on the estimated exhalation flow；And

Detect second trigger condition in response to described and trigger air-breathing during the ventilation.

Another aspect of the present invention describes a kind of respirator system, and it is included：Pressure generating system；Venting tubing system, It includes the patient interface for being used for that the pressure generating system to be connected to patient；Exhalation valve, it is connected to the breather line System；Multiple sensors, it is operatively coupled to the pressure generating system, the patient and the breather line system At least one of system；Breathe out flow estimation module, driver；Main trigger module；Standby trigger module；And controller.It is described Pressure generating system produces the respiratory air flow for including fixed base flow.The multiple sensor monitoring pressure of inspiration(Pi), inspiratory flow, exhale Go out pressure, exhalation aux. pressure and/or exhalation flow, to determine monitoring pressure of inspiration(Pi), monitoring inspiratory flow, monitoring exhale Go out pressure, monitor exhalation aux. pressure and monitor exhalation flow.The exhalation flow estimation module is based on described monitored Exhalation pressure and described monitor breathe out aux. pressure to estimate the exhalation flow to determine estimated exhalation flow.It is described to drive Dynamic device controls the exhalation valve at least based at least one of the following with by ventilation delivery to the patient：The institute Monitoring exhalation flow, and the estimated exhalation flow determined based on the exhalation pressure and the exhalation aux. pressure.Institute State main trigger module and air-breathing is triggered based on the one for occurring at least one of following event：Detect the first triggering bar Part；And predetermined exhalation time amount expires.The standby trigger module is based on the one for occurring at least one of following event And trigger air-breathing：At least based on the estimated exhalation flow detection to the second trigger condition；And the predetermined exhalation time amount Expire.The controller determine it is described monitor that exhalation flow is not present, and be switched to from the main trigger module described standby Use trigger module.

Another aspect of the present invention describes a kind of be used for the method that lung ventilator is patient ventilation.Methods described is included：

At least monitor exhalation flow come delivery of ventilation based on described；

Determine it is described monitor exhalation flow be not present；

It is not present in response to described monitor described in exhalation flow, at least monitor that breathing out pressure estimates based on described It is described to breathe out flow to determine estimated exhalation flow；And

In response to it is described monitor exhalation flow described in be not present, at least based on it is described monitor breathe out flow and stop The conveying ventilation, and at least it is based on the estimated exhalation flow alternatively delivery of ventilation.

Reading described in detail below and checking after associated drawings it will be evident that characterizing system described herein And these and various other features and advantage of method.Additional features are set forth in following description, and Partial Feature will It is apparent or can be learnt by putting into practice the technology from the description.By the structure specifically noted in written description and herein Claims and accompanying drawing will recognize that and realize the benefit and feature of the technology.

It should be understood that overall description above and it is described in detail below be all exemplary and illustrative, and be intended to carry For of the invention being explained further to what is advocated.

Brief description of the drawings

The all figures of following drafting for forming the part of the application illustrate the embodiment of system hereinafter described and method, and not Intention limits the scope of the present invention in any way, and the scope of the present invention will be based on claims.

Figure 1A is the schema for the embodiment for illustrating exemplary lung ventilator.

Figure 1B illustrates the embodiment of the lung ventilator shown in Figure 1A.

Fig. 2 illustrates the embodiment of the method for triggering air-breathing on lung ventilator during patient is ventilated.

Embodiment

Although technology described above and being hereafter discussed in detail can be implemented to be used for a variety of medical treatment devices, the present invention will Discuss embodiment of these technologies in the context for providing the medical ventilator that ventilation is supported for human patientses.It is affiliated The technical staff in field will be understood that, the technology described in the context for the medical ventilator of human patientses may be adapted to For example it is used together for the lung ventilator of non-human patients and other systems of general gas flow transportation system.

Medical ventilator is used to provide breathing gas for the patient that script may not be breathed fully.Set in modern medical service Shi Zhong, can usually obtain forced air and source of oxygen from wall socket.Therefore, lung ventilator, which can be provided, is connected to forced air and adds Press the pressure-regulating valve (or adjuster) of the concentrated source of oxygen.Regulating valve to adjust flow so that in wanted pressure and The breathing gas with wanted oxygen concentration is fed to patient under speed.Can be independently of exhaling that external pressurized air-source is operated Suction machine is also available.

Because each patient may require different ventilation strategies, therefore it can be exhaled for the specific needs customization of few patients Suction machine.For example, some different lung ventilator patterns have been set up or have set to provide more for patient under various different situations Good ventilation, such as forced-ventilation pattern and assist-control ventilation pattern.Auxiliary control model allows the patient of autonomous respiration to exist Air-breathing is triggered during ventilation.

Medical ventilator represents the response performance that patient is triggered to sucting stage from the exhalation stage weight of medical ventilator Want characteristic.The work of breathing of the triggering response influence patient of lung ventilator and whole man-machine synchronization.The triggering response performance of lung ventilator is The air-breathing behavior (respiration capability value and temporal characteristicses) of patient, and the gas of lung ventilator convey dynamics, Row control ginseng Number (actuator response, dead band etc.) and the function for triggering algorithm.

In traditional flow triggering pattern, detected based on the flowrate measurement value deviation produced by the gettering ability as patient The inspiration trigger of patient.In flow triggering pattern, lung ventilator conveys fixed base flow during the exhalation stage.Therefore, meter is passed through Calculate lung ventilator net flow (base flow-discharge air-flow) and by it compared to sensing flow for the setting activation threshold value triggered Deviation.As used herein, when the situation that should trigger respiratory delivery occurs, trigger condition is met.For example, when When violating or being had expired beyond activation threshold value, predetermined time amount and/or breathe out flow and become to stablize, trigger condition is met.

Base flow by the air-flow conveyed during exhalation and its be made up of being combined for appropriate gas.Fixed base flow can be by adjusting Actuator (valve) is saved to maintain the controller for wanting constant flow speed from adjusted pressurized-gas source to lung ventilator loop to produce It is raw.The value or flow rate produced by adjuster in different release positions is determined by inspiratory flow sensor.Therefore, base Stream is by lung ventilator via inspiratory flow sensor is transported to the throughput of patient and determined by measuring during breathing out.

Discharge air-flow is measured during the expiration phase that lung ventilator is breathed when base flow conveys and passes through patient circuit.Art Language " expiration " and " exhalation " are interchangeable herein to be utilized.Therefore, term " expiration " covers term " exhalation ", and term " exhalation " Cover " expiration ".Term " expiration " and " exhalation " are herein to patient during representing and then from its lung's exhaled gas The patient respiratory stage of expiratory phase.To determine the gas capacity breathed out by patient, by net flow, (total feed flow, which is subtracted, to be passed through Breathe out the total flow of module) it is used to integrate.That is, from base flow and pass through breathe out port discharge patient air flow summation button Except conveyed base flow.During the activation phase that patient breathes out the air-flow of discharge exhalation module be the base flow that is conveyed by lung ventilator and The summation of exhaled air flow from patient lungs.

In the case of lung ventilator failure and/or the system failure, lung ventilator generally sends alarm and stops ventilation.Lung ventilator Because for convey the call parameter to be ventilated it is unreliable or be attributed to failure not can determine that and stop ventilate.

For example, if lung ventilator utilizes dry systems and/or component to control the autonomous triggering of respiratory delivery to patient, Such as gas source, intake guide and valve, air-breathing module, exhalation conduit and valve, exhalation module and controller.Expiration module utilizes institute Measure expiratory gas flow and/or breath pressure to control exhalation valve, throughput and/or pressure are wanted to be conveyed during air-breathing and exhalation Power.For example, controller controls when to convey based on the autonomous respiration ability from patient that can be determined by exhalation flow Air-breathing.If exhalation flow is unavailable, lung ventilator can not determine when that therefore triggering stops to patient and respiratory delivery Ventilation.The patient that the respiration capability of its own weakens is arrived however, it is expected that will ventilate and provide.Therefore, system disclosed herein And method provides ventilation in the case of exhalation flow is disabled and maintains comfortable man-machine synchronization.

In certain embodiments, exhalation module breathes out flow sensor comprising removable.Breathing out flow sensor can be through Remove to be cleaned and/or replaced.Flowed in the case of in the absence of exhalation flow sensor, under error condition or in exhalation During the failure of quantity sensor, exhalation flow is unknown or insecure.Therefore, monitor that exhalation flow is unreliable or can not be true Determine, therefore conventional flow triggering algorithm is not useable for comparing net flow (base flow-discharge air-flow) and activation threshold value.Therefore, it is sharp The triggering that patient originates can not be detected with the lung ventilator of conventional triggering method, and is removed or occurs in exhalation flow sensor Expiratory positive airway pressure pattern can not be used during failure in these lung ventilators.However, when exhalation flow not can determine that, such as institute herein The system and method for description is estimated to breathe out flow using monitored breath pressure and/or monitored expiration aux. pressure.

The example of error condition is presented by exhalation back up ventilation (EBUV) pattern, DATA REASONING and acquisition under the pattern Subsystem is because the data from exhalation flow sensor are unavailable and/or unreliable and calculate estimated exhalation flow.As above Text is discussed, and most of conventional ventilators issue alarm simultaneously terminates ventilation.However, EBUV patterns allow lung ventilator in such condition Under continue as patient ventilation, reduced respiration capability and increased man-machine synchronization are maintained whereby when compared to conventional ventilators.

Therefore, system and method described herein provide for exhalation flow can not be determined by lung ventilator/can not By Use of respirator when trigger mechanism.For example, when detecting failure in breathing out flow sensor, and/or it ought exhale Flow sensor it is removed for cleaning and/or replacing when, exhalation flow can not be determined by lung ventilator.Flow need not be breathed out The ability triggered allows EBUV patterns to maintain comfortable man-machine synchronization.System and method described herein is provided and exhaled Trigger mechanism for autonomous patient when suction machine can not determine to breathe out flow.Lung ventilator is based on monitoring exhalation pressure and/or exhaled Go out aux. pressure to estimate to breathe out flow.Estimated exhalation flow is replaced into actual exhalation flow, so as to allow using traditional Flow triggering algorithm.For example, lung ventilator can be by calculating exhaling compared to the setting activation threshold value for being triggered Suction machine net flow (base flow-estimated discharge air-flow) determines flow deviation.

Figure 1A and 1B is the schema for the embodiment for illustrating exemplary lung ventilator 100.Illustrated exemplary breathing in Figure 1A Machine 100 is connected to human patientses 150.Lung ventilator 100, which is included, to be used to breathing gas is recycled into trouble via venting tubing system 130 Person 150 and the pneumatic system 102 (being also called pressure generating system 102) from patient's circulatory and respiratory gas, the ventilation Pipe-line system is via invasive (for example, tracheal strips pipeline as demonstrated) or Noninvasive (for example, nose cup) patient interface 180 Patient 150 is coupled to pneumatic system 102.Pneumatic system 102 according to predetermined or selected pattern (autonomous, auxiliary, force etc.) and Type of respiration (Stress control, pressure support ventilation, pressure auxiliary, volume controlled, capacity are supported, capacity controlled pressure mark is limited etc.) will be logical Gas is transported to patient 150.

Venting tubing system 130 (or patient circuit 130) can be for gas to be carried into patient 150 and from the patient Two branches (displaying) of carrier gas or a duplexure.In two branch embodiments, it is possible to provide commonly referred to as " Y shape is matched somebody with somebody The accessory of part " 170 by patient interface 180 (nose cup in the tracheal strips pipeline and Figure 1B that are shown as in Figure 1A) to be coupled to ventilation The inspiratory limb 132 of pipe-line system 130 and exhalation branch 134.

Pneumatic system 102 can be configured in many ways.In this example, pneumatic system 102 is included and exhalation branch The exhalation module 108 of 134 couplings, and the air-breathing module 104 coupled with inspiratory limb 132.Compressor 106, reservoir 124 are (such as It is illustrated in Figure 1B) and/or other pressurized-gas sources (for example, air, oxygen and/or helium) and air-breathing module 104 and exhalation Module 108 couples to provide the gas source supported for ventilating via inspiratory limb 132.In one embodiment, pneumatic system 102 Couple and received sometimes from the controller with controller 110 to operably and instructed.

Air-breathing module 104 is configured to deliver gas to patient 150 according to the ventilation of regulation setting and/or conveying passes through Inspiratory limb 132.Air-breathing module 104 is associated with air-breathing transfer valve 101 and/or controls the valve, and patient is arrived for control 150 gas is conveyed and/or the gas by inspiratory limb 132 as is illustrated in figure ib is conveyed.In certain embodiments, inhale Gas module 104 is configured to provide ventilation according to various lung ventilator patterns, for example, force and auxiliary mode.

Exhalation module 108 is configured to the lung and/or exhalation loop release gas from patient according to the ventilation setting of regulation Body.Therefore, exhalation module 108 also controls by inspiratory limb 132 and breathed out the gas conveying of branch 134.Exhalation module 108 is controlled Exhalation valve 123 processed, to maintain defined patient airway pressure and discharge air-flow from the lung of patient.

Lung ventilator 100, which can be included, to be used to control exhalation valve 123, exhalation driving valve 125 and/or exhalation pump 126 (for example to spray Pump) driver 103.In certain embodiments, driver 103 is such as the portion of exhalation module 108 illustrated in Figure 1A and 1B Point.In other embodiments, driver 103 be contained in lung ventilator 100 different system or module (for example pneumatic system 102 or Controller 110) in.The control exhalation valve 123 of driver 103 reaches wanted pressure of inspiration(Pi) with the superpressure conveyed during reducing suction Power.In addition, driver 103 controls exhalation valve 123 to want PEEP to be conveyed during breathing out.In certain embodiments, based on logical Cross using monitoring exhalation pressure and monitor that breathing out the control algolithm that is calculated of flow controls driver 103.Monitored Exhalation flow and pressure are determined by one or more of multiple sensors 107 for discussing in further detail below.

In certain embodiments, driver 103 is differential driver.In other embodiments, driver 103 is that pulse is wide Spend modulating driver.Driver cited hereinabove is not intended to be restricted.Lung ventilator 100 is breathed using control is used for Any proper driver of exhalation module 108 in machine.

In certain embodiments, as is illustrated in figure ib, the drive circuit 103a of driver 103 is communicably coupled to exhale Go out valve 123 and one or more exhalation sensors, expiratory flow sensor 111a, breath pressure for example as is illustrated in figure ib are passed Sensor 111b and exhalation auxiliary pressure sensor 111c.In additional embodiment, the drive circuit 103a communications of driver 103 It is coupled to exhalation pump 126 and exhalation driving (such as electromagnetism of valve 125 positioned at exhalation auxiliary pressure sensor 111c upstream in ground Valve).In addition, driver 103 is communicably coupled to the other systems and module of lung ventilator 100, for example, breathe out module 108, air-breathing Module 104 and/or controller 110.

Breath pressure sensor 111b and exhalation auxiliary pressure sensor 111c is the different positions in monitoring exhalation branch 134 Put the pressure sensor of the gas pressure at place.Pressure sensor 111b is breathed out located immediately at the exhalation flow path from patient In, and to determine, monitoring breathes out pressure to gas pressure of the monitoring from patient.It is positioning to breathe out auxiliary pressure sensor 111c In the second place for being different from breathing out pressure sensor 111b position in exhalation branch 134 except exhalation pressure sensor Any pressure sensor outside 111b.In certain embodiments, exhalation auxiliary pressure sensor 111c is as described in Figure 1B Bright exhalation driving pressure sensor.Exhalation driving pressure sensor positions for the exhalation flow path away from patient (or), and alternatively monitoring is from exhalation pump 126 and/or breathes out driving. not directly with exhalation flow path point-blank The sensor of the gas pressure of valve 125 monitoring exhalation driving pressure to determine.Therefore, breathe out pressure or monitor exhalation pressure It is to be determined from exhalation flow sensor 111b reading.In addition, exhalation aux. pressure or monitoring that it is from exhaling to breathe out aux. pressure The reading for going out auxiliary pressure sensor 111c is determined.In addition, breathing out driving pressure or monitoring an exhalation driving pressure (type Exhalation aux. pressure) be from exhalation driving pressure sensor (a type of auxiliary pressure sensor 111c) reading it is true It is fixed.

Lung ventilator 100 also includes the main trigger module 113 of the ventilation setting triggering air-breathing according to regulation.In some embodiments In, as illustrated in FIG. IA, main trigger module 113 is contained in controller 110.In other embodiments, main trigger module 113 In the different system or module that are contained in such as pneumatic system 102.In one embodiment, main trigger module 113 is based at least two One in individual event and trigger air-breathing, the event such as predetermined time amount expires and detected the first trigger condition. In other embodiments, main trigger module 113 is expired and/or detected the first trigger condition based on predetermined expiratory duration amount and triggered Air-breathing.

Some different the trigger event types or system for the first trigger condition of detection are utilized in the presence of by lung ventilator 100 And/or method.In certain embodiments, for detecting that the trigger event type of patient respiratory ability can be selected or defeated by operator Enter.In certain embodiments, trigger event type is selected automatically by lung ventilator.Lung ventilator is using for determining that patient triggers thing The detection of the detection trigger of any suitable type of part, such as nose, barrier film detection and/or brain signal detection.In addition, lung ventilator Can be via pressure monitoring method, traffic monitor method, the direct or indirect measurement of neuromuscular signals or any other appropriate parties Method come detect patient trigger.Sensor 107 suitable for this detection can include those skilled in the art such as and become known for breathing Any suitable sensing device further of machine.In addition, lung ventilator can be adjusted to the susceptibility that pressure and/or flow change so that breathing Machine can be appropriately detected patient respiratory ability, that is to say, that the setting that pressure or flow change is lower, and lung ventilator is touched to patient The susceptibility of hair can be higher.

Alternatively, lung ventilator can detect flow triggering event.Specifically, lung ventilator can monitoring circuit flow, as above It is literary described.Decline if lung ventilator detects a small amount of flow during exhaling, this may indicate that patient just attempts air-breathing again. Under this situation, lung ventilator, which is detected, to be attributable to a small amount of gas and is redirected to the lung of patient (in response to as discussed above Slight negative pressure gradient) baseline flow measurement (or base flow) decline.Base flow refer to enable lung ventilator detect expiratory gas flow change and Patient triggering in the constant gas being present in during exhaling in loop.For example, although gas is generally in the expiration phase Between flowed out from the lung of patient, but it can be due to some gases in response to light between patient lungs and body surface that flow, which declines, Tiny structure gradient and it is redirected and flow in lung and occur.Therefore, predetermined threshold is reached less than base flow when lung ventilator is detected When a small amount of flow of amount declines (for example, less than base flow 2L/min), then the decline can be construed to patient's trigger event and can Therefore air-breathing is originated by conveying breathing gas.

In one embodiment, lung ventilator 100 through pre-configured to convey air-breathing after predetermined expiratory duration amount, to prevent Patient 150 becomes hypoventilation.Therefore, predetermined expiratory duration amount (for example, being referred to as apnea interval in some lung ventilators) It is activation threshold value in this embodiment.For example, main trigger module 113 by the expiratory duration of 20 seconds, 30 seconds or 60 seconds it Air-breathing is automatically triggered afterwards.In certain embodiments, predetermined time amount is to be based on patient by clinician and/or lung ventilator 100 Whether 150 for baby, children, adult, male, women and/or just determining by the specified disease patient's condition.

Lung ventilator 100 is included when the failure detected by controller 110 establishes expiratory gas flow and not can determine that or be unreliable Estimate the flow estimation module 117 of expiratory gas flow.In certain embodiments, as illustrated in FIG. IA, controller 110 includes flow Estimation module 117.In other embodiments, pneumatic system 102 includes flow estimation module 117.Term " not can determine that " with " no Reliably " although with different implications, herein interchangeable utilization.Therefore, term " unreliable " cover term " can not be true It is fixed ", and term " not can determine that " covers " unreliable ".In previous system, if expiratory gas flow not can determine that or if exhale Flow sensor 111a is removed, then may no longer convey expiratory positive airway pressure using the lung ventilator of conventional triggering method.In order to provide Expiratory positive airway pressure, lung ventilator 100 based on as by one or more of multiple sensors 107 determine the breath pressure that monitors and/or Monitored expiration aux. pressure estimates expiratory gas flow.Due to estimating expiratory gas flow, therefore lung ventilator 100 can continue autonomous logical Gas, so as to maintain man-machine synchronization and/or patient comfort.In certain embodiments, flow estimation module 117 is expiration module 108 part, and it is communicably coupled to expiratory flow sensor 111a, breath pressure sensor 111b and/or auxiliary pressure of exhaling Force snesor 111c.In other embodiments, flow estimation module 117 is the part of air-breathing module 104 or controller 110.Stream Amount estimation module 117 is also communicably coupled to standby trigger module 115.

In certain embodiments, flow estimation module 117 determines estimated expiratory gas flow using below equation #1：

Wherein,

P_exp=measured expiratory pressure the force value in units of cmH2O；

P_drv=measured expiration the auxiliary pressure level in units of cmH2O；

Q_exp=measured expiratory gas flow (EVQ) value in units of lpm；And

A, b, c=constant coefficients.

In order to utilize equation #1, calibrated by lung ventilator 100 or flow estimation module 117 when expiratory gas flow can determine that Constant flow rate coefficient is determined during test.Calibration test measures when being included in delivered constant expiratory gas flow and stores P_expAnd P_drv's Value.This can be tested in triplicate by conveying different expiratory gas flows every time.Stored P_exp、P_drvAnd Q_expFor by solving Equation #1 listed above and obtain constant coefficients a, b and c.Once it is determined that being used for the constant coefficients of a patient, until needing Identified constant coefficients are all stored by lung ventilator 100 or flow estimation module 117 when wanting.Supervised when controller 110 is detected When not can determine that depending on expiratory gas flow or be unreliable, flow estimation module 117 exports equation #2 listed hereinafter from equation #1 To determine estimated expiratory gas flow：

Wherein,

=estimated expiratory gas flow (EVQ) value in units of lpm.

Because expiratory gas flow can not be determined during expiratory flow sensor 111a removal or failure, institute can be based on Estimation expiratory gas flow determines to convey PEEP amount.Control to calculate in addition, estimated expiratory gas flow is used for air-breathing by air-breathing module 104 In method pressure of inspiration(Pi) is wanted to convey.Driver 103 is controlled based on expiration control algolithm to exhale by using estimated to convey The PEEP of flow rate calculation.Monitored breath pressure and/or aux. pressure are determined by one or more of multiple sensors 107. In certain embodiments, monitor that breath pressure and/or expiration aux. pressure are by breath pressure sensor 111b and exhaled auxiliary Pressing aid force snesor 111c is determined.

In additional embodiment, when expiratory gas flow not can determine that, generally determine or calculate by using expiratory gas flow Other parameters be by using estimated expiratory gas flow determine.For example, determine to be estimated using estimated expiratory gas flow Meter exhalation tidal volume.In certain embodiments, flow estimation module 117 is based on estimated expiratory gas flow and determines these additional estimateds Parameter.In other embodiments, controller 110 or pneumatic system 102 are based on estimated expiratory gas flow and determine these additional estimateds Parameter.These estimation parameters of such as estimated expiration tidal volume are communicated to other components of lung ventilator 100, such as display 122。

In addition, in certain embodiments, lung ventilator 100 includes standby trigger module 115.In certain embodiments, it is standby Trigger module 115 is when lung ventilator is in EBUV patterns according to the ventilation of regulation setting triggering air-breathing.When lung ventilator 100 or breathing When the subsystem (such as controller 110) of machine detects expiratory flow sensor 111a failure or removal, controller 110 is utilized Standby trigger module 115.Failure/removal hinders and determines monitored expiratory gas flow.In certain embodiments, as described in Figure 1A Bright, controller 110 includes standby trigger module 115.In other embodiments, pneumatic system 102 includes standby trigger module 115。

In certain embodiments, standby trigger module 115 triggers air-breathing based on the one at least two events, for example Predetermined time amount expires and detected the second trigger condition.In other embodiments, standby trigger module 115 is based on the scheduled time Amount expires and/or detected the second trigger condition and triggers air-breathing.In certain embodiments, the second trigger condition is based on flow The activation threshold value of deviation.In another embodiment, the second trigger condition is inspiration trigger threshold value.In one embodiment, it is standby to touch Hair module 115 is using the fixation base flow (such as (but not limited to) 1.5LPM) conveyed by pneumatic system 102 and by flow estimation mould The estimated expiratory gas flow that block 117 is estimated, to determine compared to the flow deviation or net flow of activation threshold value.If flow is inclined Difference violates activation threshold value, then controller 110 indicates the conveying breathing of pneumatic system 102.

In certain embodiments, by adding or subtracting one from fixed the other of base flow and estimated exhalation flow To determine flow deviation.Because exhalation flow not can determine that, estimated exhalation flow will be compared to firing level for determination The flow deviation of value.Lung ventilator is allowed to trigger autonomous respiration continuing with the patient using estimated exhalation flow, so that because This maintains man-machine synchronization and patient comfort.Estimated exhalation flow is determined by flow estimation module 117.In one embodiment, If standby trigger module 115 determines that lung ventilator and/or patient parameter are met and/or beyond inspiration trigger threshold during breathing out It is worth, then standby trigger module 115 indicates that air-breathing module 104 conveys air-breathing, and this effectively terminates the exhalation stage.In another embodiment In, standby trigger module 115 is contained in such as different system of pneumatic system 102.

If standby trigger module 115 determines lung ventilator and/or patient parameter during breathing out and is unsatisfactory for and/or exceeds Inspiration trigger threshold value, the then standby continuation of trigger module 115 monitors lung ventilator and/or patient parameter and by it compared to firing level Value, until lung ventilator and/or patient parameter meet and/or can determine that beyond activation threshold value, exhalation flow or until predetermined exhalation Untill time quantum expires.If not violating activation threshold value in predetermined time amount, lung ventilator 100 will be in predetermined exhalation time amount Breathing is conveyed when expiring.In certain embodiments, predetermined exhalation time amount (such as (but not limited to) 20 seconds, 30 seconds or 60 seconds Exhalation time) start passage after conveying breathing.Predetermined time amount can be inputted by clinician or calculated by lung ventilator.

In another embodiment, when patient 150 reaches the stable exhalation part such as determined by standby trigger module 115, Meet the second trigger condition.In order to determine stable exhalation part, lung ventilator 100 monitors estimated exhalation flow.In some implementations In example, standby trigger module 115 collects multiple exhalation flows within the setting cycle after being expired during breathing out in the restriction cycle Estimation.It is as used herein that to limit the cycle be the predetermined period of time started in exhalation beginning.Patient 150 is stopped in Ventilation is triggered during the predetermined period of time in restriction cycle.For example, it can be 25ms, 50ms, 100ms, 200ms to limit the cycle And/or for preventing patient 150 from triggering any other suitable time cycle of air-breathing.In other embodiments, standby triggering Module 115 determines stable exhalation part in the case where not utilizing the restriction cycle.In one embodiment, standby trigger module 115 Stability is determined by monitoring the exhalation flow estimated by each calculating circulation.In certain embodiments, it is every to calculate circulation 5ms.If the difference between two continuous exhalation flow estimations is zero or about zero, stable exhalation part is had determined that and standby It will indicate that lung ventilator 100 conveys breathing with trigger module 115.In Additional examples of composition, when patient 150 is reaching stable exhalation portion / after detect when such as being changed by negative sense base flow that standby trigger module 115 is determined, meet the second trigger condition.

In certain embodiments, trigger module 113,115, which changes flow rate, is used as inspiration trigger threshold value.Citing comes Say, inspiration trigger threshold value can for -1.5 liters per minute (LPM), -2LPM, -3LPM, -4LPM, -5LPM, -6LPM, -7LPM and - 8LPM flow rate changes, or the scope that can change for flow rate, such as -3LPM's to -6LPM or -4LPM to -7LPM Scope.This list is only exemplary and is not intended to be restricted.Trigger module 113,115 can utilize any suitable stream Dynamic speed changes for triggering air-breathing.For example, in certain embodiments, any inspection that activation threshold value is at least 1.5LPM The flow rate measured declines.

Controller 110 to operably with pneumatic system 102, the signal of such as (but not limited to) multiple sensors 107 Measurement and acquisition system, and operator interface 120 are coupled, and the operator interface may be such that operator can be with lung ventilator 100 Interaction (for example, change lung ventilator setting, selection operation pattern, check monitored parameter etc.).

In certain embodiments, controller 110 includes memory 112, one or more processors 116, storage device 114 And/or other component types in order and control computing device are common in, as illustrated in FIG. IA.In alternate embodiment In, controller 110 is the component for being located away from operator interface 120 and pneumatic system 102.In other embodiments, controller 110 In other components of lung ventilator 100, such as in pressure generating system 102 (also referred to as pneumatic system 102).

Memory 112 includes non-transitory computer-readable storage medium, and its storage is performed by processor 116 and controls to exhale The software of the operation of suction machine 100.In one embodiment, one or more of memory 112 comprising such as flash memory chip are consolidated State storage device.In an alternative embodiment, memory 112 can be by mass storage device controller (not shown) and lead to Letter bus (not shown) is connected to the mass storage device of processor 116.Although the computer-readable media contained herein Description refer to solid-state storage device, it is understood by those skilled in the art that computer-readable storage medium can be for can be by Any useable medium that processor 116 is accessed.For example calculated for storage that is, computer-readable storage medium includes Non-transitory that machine readable instruction, data structure, any method or technique of the information of program module or other data are implemented, easily The property lost and non-volatile, removable and non-removable formula media.For example, computer-readable storage medium comprising RAM, ROM, EPROM, EEPROM, flash memory or other solid-state memory technologies, CD-ROM, DVD or other optical storage, Cassette tape, tape, disk storage device or other magnetic storage devices, or want information and can be by computer available for storage Any other media of access.

In addition, controller 110 determines whether exhalation flow not can determine that and/or unreliable.Therefore, controller 110 is determined Whether exhalation flow sensor 111a has removed or has breathed out whether flow sensor 111a breaks down.If controller 110 is true Surely exhalation flow sensor 111a is removed and/or broken down, then monitored expiratory gas flow is unreliable.

It is current in art to utilize and become known for determining the failure in sensor or for determining sensor whether Removed some different systems and method.Controller 110 detects event using any one of these known systems or method Barrier is removed.For example, can based on the exhalation flow sensor 111a of exhalation module 108 voltage changes, temperature changes, watt Number changes, coefficient changes, humidity changes and/or excessively stream changes to detect failure or removal.

If controller 110 determines exhalation, flow not can determine that controller 110 is switched to standby from main trigger module 113 The switching is carried out with trigger module 115 or instruction.In one embodiment, the standby activation of trigger module 115 flow estimation module 117, it estimates to breathe out flow based on pressure of inspiration(Pi) and/or monitored inspiratory flow is monitored.Lung ventilator 100 even can be Exhalation flow sensor maintains autonomous respiration ventilating mode when being removed or breaking down.During autonomous respiration ventilating mode, Inspiration trigger is based on estimated exhalation flow rather than monitors exhalation flow.In addition, controller 110 indicates pneumatic system 102 Convey EBUV ventilating modes.EBUV patterns are expiratory positive airway pressure pattern.Patient will be directed to during the air-breathing of autonomous respiration and exhalation The pressure of 150 management is determined by lung ventilator 100.In addition, the inspiratory duration and respiratory rate for patient 150 are also by breathing Machine 100 is determined.These variables determine to be transported to the pressure of the gas of patient 150 during each autonomous respiration air-breathing and exhalation.It is right In EBUV patterns, upon inhalation between when being equal to defined inspiratory duration, the starting exhalation of lung ventilator 100.Exhalation terminates to hold from air-breathing Continue to until detecting inspiration trigger or untill predetermined time amount expires.After inspiration trigger is detected, by it is another from Patient 150 is given in main breathing.

During EBUV patterns, lung ventilator 100 maintains uniform pressure waveform at oral cavity, but regardless of lung or gaseous path's characteristics Change, for example breathe compliance and/or respiratory resistance.However, capacity and flow waveform can be based on lungs and gaseous path's characteristics Change.In certain embodiments, lung ventilator 100 (is for example weighed based on the known breath machine parameter for not yet being determined failure destruction Amount, height, sex, age and disease state) determine setting pressure (comprising pressure of inspiration(Pi) and PEEP), inspiratory duration and breathing Speed.In other embodiments, setting pressure (including pressure of inspiration(Pi) and PEEP), inspiratory duration and respiratory rate are by lung ventilator 100 make a reservation for after not confirmable exhalation flow is detected, and it is for any patient 150 ventilated by lung ventilator 100 Identical.

If controller 110 and be not determined by failure or and be not determined by be not present exhalation flow, controller 110 is not Change to standby trigger module 115 and continue with the main triggering of trigger module 113 air-breathing.In certain embodiments, if control The determination of device 110 is out of order or determined in the absence of flow is breathed out, then controller 110 is switched to standby touch from main trigger module 113 Module 115 is sent out to trigger air-breathing.In certain embodiments, controller 110 is the part of exhalation module 108.In some embodiments In, controller 110 is the part of pneumatic system 102.In other embodiments, controller 110 is to be located away from pneumatic system 102 Module.

Lung ventilator 100 is also comprising the multiple sensors 107 for being communicably coupled to lung ventilator 100.Sensor 107 can be located at gas In dynamic system 102, in venting tubing system 130 and/or on patient 150.Figure 1A embodiment illustrates in pneumatic system 102 Multiple sensors 107.

Sensor 107 can communicate with the various assemblies of lung ventilator 100, such as pneumatic system 102, other sensors 107, exhale Go out module 108, air-breathing module 104, processor 116, controller 110 and any other suitable component and/or module.At one In embodiment, sensor 107 produces output and this output is sent into pneumatic system 102, other sensors 107, exhalation module 108th, air-breathing module 104, processor 116, controller 110, main trigger module 113, standby trigger module 115, flow estimation mould Block 117 and any other suitable component and/or module.

Sensor 107 can monitor that the ventilation with patient 150 is associated using any suitable sensation or derivation technology One or more patient parameters or ventilator parameter.Sensor 107 is detectable (for example) to indicate that patient breaths or exhalation triggering are exhaled The patient parameter of energy-absorbing power changes.Sensor 107 can be positioned over (such as) ventilating return or be communicably coupled to lung ventilator 100 In any correct position in other devices.In addition, sensor 107 can be positioned in such as ventilating return or lung ventilator 100 In any suitable internal position in component or module.For example, sensor 107 can be coupled to air-breathing module 104 and/or exhale Go out module 108, change for detection (such as) inspiratory flow, pressure of inspiration(Pi) changes, breath pressure changes and expiratory gas flow changes Become.In other examples, sensor 107 can attach to breather line 130 or can be embedded in pipeline itself.According to some implementations Example, sensor 107 may be provided at or near lung's (or barrier film), for the pressure in detection lung.Additionally or alternatively property Ground, sensor 107 can attach or be embedded in Y shape accessory 170 and/or patient interface 180 or near.Can be according to being retouched herein The embodiment stated utilizes any sensory device for the change that can be used for monitoring measurable parameter during ventilation treatment.

For example, in certain embodiments, one or more sensors 107 of lung ventilator 100 are included as described in Figure 1B Bright inspiratory flow sensor 109a and exhalation flow sensor 111a.In one embodiment, inspiratory flow sensor 109a Controlled in inspiratory limb 132, and by air-breathing module 104 and/or flow estimation module 117.However, inspiratory flow sensor 109a can be located at for monitoring inspiratory flow in any correct position, and (can for example be pressed by any suitable breathing thermomechanical components Power generation system 102) monitoring.In one embodiment, exhalation flow sensor 111a is located in exhalation branch 134, and by exhaling Go out module 108 and/or controller 110 (comprising main trigger module 113 and/or standby trigger module 115) monitoring.However, exhalation Flow sensor 111a can be located in any correct position for monitoring exhalation flow, and can be by any suitable breathing unit Part (such as pressure generating system 102 and driver 103) is monitored.In certain embodiments, exhalation flow sensor 111a is can Removable and the downstream positioned at exhalation valve 123 as is illustrated in figure ib.

In addition, in certain embodiments, one or more sensors 107 of lung ventilator 100 are also comprising as is illustrated in figure ib Inspiratory pressure sensor 109b, exhalation pressure sensor 111b and/or exhalation auxiliary pressure sensor 111c.In an implementation In example, inspiratory pressure sensor 109b is located in inspiratory limb 132, and is controlled by air-breathing module 104 and flow estimation module 117 System.However, inspiratory pressure sensor 109b can be located at for monitoring pressure of inspiration(Pi) in any correct position, and it can be closed by any Suitable breathing thermomechanical components (such as pressure generating system 102) monitoring.In one embodiment, exhalation pressure sensor 111b is located at Breathe out in branch 134, and monitored by exhalation module 108 and/or controller 110.However, exhalation pressure sensor 111b can be located at For monitoring exhalation pressure in any correct position, and can be by any suitable breathing thermomechanical components (such as pressure generating system 102 and driver 103) monitoring.In certain embodiments, as is illustrated in figure ib, exhalation pressure sensor 111b is located at exhalation The upstream of pump 126 and/or exhalation valve 123.Breathe out auxiliary pressure sensor 111c and be located at exhalation pump 126 in exhalation branch 134 Downstream, and monitored by exhalation module 108 and/or controller 110.Appoint however, exhalation auxiliary pressure sensor 111c can be located at For monitoring exhalation aux. pressure in what correct position, and can be by any suitable breathing thermomechanical components (such as pressure generation system System 102 and driver 103) monitoring.

Pressure sensor 111b and exhalation auxiliary pressure sensor 111c measurement exhalation pressure are breathed out, and breathes out flow sensing Device 111a measurement exhalation flows.It is different from exhalation pressure sensor 111b and exhalation aux. pressure to breathe out flow sensor 111a Sensor 111c sensor type.

As should be appreciated, with reference to equation of motion, ventilation parameters are height correlations, and according to embodiment, can directly or Ground connection monitoring ventilation parameters.That is, parameter can be directly monitored by by one or more sensors 107, as described above, or can Monitored indirectly according to equation of motion or other known relation by deriving or estimate parameter.

In certain embodiments, the error of measurement value sensor is adjusted.In certain embodiments, adjustment exhalation flow sensing Device 111a error.For example, can be by exhalation flow sensor 111a readings compared to patient during traffic alignment is tested Another more accurate flow sensor in loop 130.It can be calculated by lung ventilator 100 and store the 111a measurements of exhalation flow sensor Difference between value and the measured value of this another flow sensor.In certain embodiments, inspiratory flow sensor flows than exhalation Quantity sensor 111a is more accurate, and is passed during traffic alignment is tested using the inspiratory flow sensor with calculating exhalation flow Sensor error.This saved differences should represent breathe out flow sensor 111a errors, and thus can be added to after the calibration Each exhalation flow sensor 111a measured values during patient ventilation determine error to adjust this.Adjustment exhalation flow sensing The error of device 111a or other sensors can improve man-machine synchronization.

Pneumatic system 102 can include a variety of other components, include mixing module, valve, pipeline, reservoir 124, filter Deng.For example, Figure 1B explanations use reservoir 124.

In one embodiment, the operator interface 120 of lung ventilator 100, which is included, is communicably coupled to the aobvious of lung ventilator 100 Show device 122.Display 122 provides the various entr screens for receiving clinician's input, and for being presented to clinician The various display screens of useful information.In one embodiment, display 122 is configured to include graphical user interface (GUI). GUI can be interactive display (for example, touch-sensitive screen or other), and can provide for receive input and interface command operation it is each Plant window and element.Alternatively, with other proper communication components of lung ventilator 100 can (for example) by roller, keyboard, mouse or Other suitable interactive devices are provided.Therefore, operator interface 120 can be taken orders and be inputted by display 122.

Display 122 may also provide the useful information in various ventilation data forms of the physical qualification on patient 150. Useful information can be as lung ventilator 100 based on as the data export collected by processor 116, and useful information can be with curve map, ripple Shape is represented, cake chart, textual form or other suitable graphic display forms are shown to clinician.For example, patient's number According to can be displayed on GUI and/or display 122.Additionally or alternatively, patient data can be communicated to via any suitable structure Part is coupled to the Long-Range Surveillance System of lung ventilator 100.In certain embodiments, display 122 can be explained EBUV patterns and/or by The use for any other information that lung ventilator 100 is known, receives or stores, for example estimated exhalation flow of described information, utilization The net flow of estimated exhalation flow, estimated exhalation tidal volume, predetermined amount of flow deviation trigger threshold value, predetermined time amount expire it The other parameters that the display of preceding remaining time is represented and/or determined based on estimated exhalation flow.

Fig. 2 illustrates the embodiment of the method 200 for triggering air-breathing on lung ventilator during patient is ventilated.This Outside, method 200 is detecting obstruction determination exhalation flow and/or is being allowed to insecure exhalation flow sensor failure or breathes out flow Quantity sensor provides ventilation after removing.The ventilation provided after exhalation flow not can determine that is herein referred to as exhalation Back up ventilation pattern (EBUV).Method 200 is started with starting ventilation.

As described, method 200 includes fixed base flow conveying operations 202.During fixed base flow conveying operations 202, exhale The fixed base flow of suction machine conveying.Fixed base flow is from inspiratory limb to continuous flow of the exhalation branch by venting tubing system.This Continuous stream allow lung ventilator trigger air-breathing and determine patient be presently in respiration phase (that is, suck, breathe out or breathe it Between).For example, if equal and in contrast to the air-flow by inspiratory limb by breathing out the air-flow of branch, lung ventilator is true Determine patient to be currently between breathing, this is due to that the air-flow for flowing in or out patient lungs is not present.In other example, such as Fruit exceeds the air-flow by breathing out branch by the air-flow of inspiratory limb, then lung ventilator determines patient's just suction and air flow direction is suffered from The lung of person.In a further example, if exceeded by breathing out the air-flow of branch by the air-flow of inspiratory limb, lung ventilator is true Determine patient's just exhalation and air-flow flows through exhalation branch from lung's (and inspiratory limb) of patient.

In addition, method 200 includes monitoring operation 204.During monitoring operation 204, lung ventilator monitoring ventilator parameter. In some embodiments, lung ventilator numerous ventilator parameters of monitoring during monitoring operation 204.As used herein, lung ventilator Parameter includes any parameter that can be monitored by lung ventilator.In one embodiment, lung ventilator monitoring air-breathing during monitoring operation 204 Flow, pressure of inspiration(Pi), exhalation flow, exhalation pressure and/or aux. pressure.Sensor suitable for this detection can be included such as by affiliated The technical staff in field becomes known for any suitable sensing device further of lung ventilator, and such as inspiratory flow sensor, pressure of inspiration(Pi) are passed Sensor, exhalation flow sensor, exhalation pressure sensor and/or exhalation auxiliary pressure sensor.In one embodiment, lung ventilator At least it is based on monitoring exhalation flow come delivery of ventilation during monitoring operation 204.

Method 200 further includes failure decision operation 206.During failure decision operation 206, lung ventilator determines exhalation Whether flow not can determine that.If lung ventilator determines exhalation flow sensor during failure decision operation 206 and is removed or such as Fruit exhalation flow sensor breaks down, then breathes out flow and not can determine that.

Some differences of the current failure or removal for utilizing and becoming known for determining exhalation flow sensor in art System and method.Lung ventilator is detected during failure decision operation 206 using any one of these known systems or method Failure or removal.For example, it can be changed based on the voltage of exhalation flow sensor, temperature changes, wattage changes, coefficient changes Become, humidity changes and/or excessively stream change detects failure or removal.In one embodiment, during failure decision operation 206, If lung ventilator determines to be out of order or remove, lung ventilator shows the information for being relevant to failure, removal or EBUV patterns, for example (but not limited to) display uses the designator of EBUV patterns, estimated exhalation flow value, flow deviation, flow deviation firing level Value, activation threshold value, the predetermined time amount as activation threshold value, estimated exhalation tidal volume, utilize it is estimated exhalation flow determine Other estimation parameters, the designator that has been removed of exhalation flow sensor or notice, and/or exist in exhalation flow sensor The designator or notice of failure.

If lung ventilator determines that exhalation flow not can determine that during failure decision operation 206, lung ventilator selection is performed Estimation operation 210.If lung ventilator can determine exhalation flow during failure decision operation 206, lung ventilator selection is performed Monitored detection trigger operation 208.

Method 200, which is included, monitors detection trigger operation 208.Lung ventilator is true during monitored detection trigger operation 208 It is fixed whether to detect the first inspiration trigger.When monitored patient and/or ventilator parameter exceed or violated inspiration trigger threshold value, Detect the first inspiration trigger.In certain embodiments, inspiration trigger threshold value is to input to receive from operator.In other embodiments In, inspiration trigger threshold value is to be based on lung ventilator and/or patient parameter.In certain embodiments, it is net negative less than conveyed base flow Inspiration trigger threshold value is changed into flow rate.For example, inspiration trigger threshold value can for -1.5LPM, -2LPM, -3LPM, - 4LPM, -5LPM, -6LPM, -7LPM and -8LPM flow rate change, or the scope that can change for flow rate, for example - 3LPM to -6LPM or -4LPM arrives -7LPM scope.This list is only exemplary and is not intended to be restricted.Lung ventilator Any proper flow speed that conveyed base flow can be will be less than during monitored detection trigger operates 208 changes tactile as air-breathing Send out threshold value.In one embodiment, by known fixed base flow with monitoring that exhalation flow is for example mathematically combined, to determine to compare In the first net flow or first flow deviation of inspiration trigger threshold value.A small amount of base flow decline during exhalation by breathing out module can Indicate that patient just attempts air-breathing.Base flow decline is attributable to gas and is redirected to the lung of patient (in response to slight negative pressure ladder Degree).

In another embodiment, when patient is reached as lung ventilator in determination during monitoring detection trigger operates 208 During stable exhalation part, the first trigger condition is met.In order to determine stable exhalation part, lung ventilator monitoring exhalation flow and/or Breathe out pressure.In certain embodiments, during monitored detection trigger operation 208, lung ventilator is limiting week during breathing out Phase expire after the setting cycle in collect it is multiple exhalation flows and/or exhalation pressure reading.It is as used herein to limit Cycle is the predetermined period of time started when breathing out and starting.Patient touches during being stopped in the predetermined period of time in restriction cycle Hair ventilation.For example, the restriction cycle can be for 25ms, 50ms, 100ms, 200ms and/or for preventing patient from triggering air-breathing Any other suitable time cycle.In one embodiment, lung ventilator passes through monitoring during monitored detection trigger operation 208 Each exhalation flow for calculating circulation determines stability.In certain embodiments, it is per 5ms to calculate circulation.If two companies Difference between continuous exhalation flow reading is zero or close zero, then has determined that stable exhalation part and lung ventilator selection execution is defeated Send operation 214.

In one embodiment, if breathing of the lung ventilator during exhalation is determined during monitored detection trigger operates 208 Machine and/or patient parameter are met and/or beyond inspiration trigger threshold value or the first trigger condition, then lung ventilator selection performs conveying behaviour Make 214.If lung ventilator and/or patient parameter of the lung ventilator during exhalation is determined during monitored detection trigger operates 208 And be unsatisfactory for and/or beyond inspiration trigger threshold value or the first trigger condition, then lung ventilator performs failure decision operation 206 again.

In one embodiment, lung ventilator through it is pre-configured with after predetermined exhalation time amount select perform conveying operations 214, to prevent patient from becoming hypoventilation.Therefore, predetermined exhalation time amount in some lung ventilators (for example, be referred to as breathing temporary Stop interval) it is activation threshold value or the first trigger condition in this embodiment.For example, lung ventilator is grasped in monitored detection trigger Execution conveying operations 214 will be automatically selected during making 208 after the exhalation time of 20 seconds, 30 seconds or 60 seconds.In some implementations In example, predetermined time amount can be inputted by clinician or calculated by lung ventilator.In certain embodiments, predetermined time amount be by Clinician and/or lung ventilator are based on whether patient is baby, children, adult, male, women and/or just by specified disease The patient's condition and determine.

Method 200 includes estimation operation 210.Lung ventilator determines estimated exhalation flow or use during estimation operation 210 More current estimated exhalation flow updates the estimated exhalation flow being previously calculated out.Exhalation flow be it is estimated draw, this It is because in the case where exhalation flow sensor breaks down or is removed, lung ventilator can not determine reliable exhalation stream Amount.For example, lung ventilator can not determine to breathe out flow during EBUV.In one embodiment, lung ventilator is in estimation operation 210 Period is based on monitoring exhalation flow and stopping providing ventilation, and at least alternatively provides ventilation based on estimated exhalation flow. Once it is determined that going out estimated exhalation flow, lung ventilator selection performs estimated detection trigger operation 212.

Lung ventilator determines to be estimated during estimation operation 210 based on exhalation pressure and/or exhalation aux. pressure is monitored Meter exhalation flow.In certain embodiments, lung ventilator determines estimated exhalation using equation #2 during estimation operation 210 Flow.In order to utilize equation #2, during estimation operation 210, lung ventilator is when exhalation flow can be determined using equation #1 Constant flow rate coefficient is determined during calibration test.Once it is determined that being used for the constant coefficients of a patient, institute stored by lung ventilator The constant coefficients of determination use for estimation operation 210.

In certain embodiments, lung ventilator determines extra ginseng during estimation operation 210 using estimated exhalation flow Number.The parameter determined using estimated exhalation flow is herein referred to as estimation parameter.For example, estimated exhalation flow It can be utilized to determine estimated exhalation tidal volume during estimation operation 210 by lung ventilator.

Method 200 includes estimated detection trigger operation 212.Lung ventilator is true during estimated detection trigger operation 212 It is fixed whether to detect the second inspiration trigger.When estimated patient and/or ventilator parameter exceed or violated inspiration trigger threshold value, Detect the second inspiration trigger.In certain embodiments, inspiration trigger threshold value is to input to receive from operator.In other embodiments In, inspiration trigger threshold value is to be based on lung ventilator and/or patient parameter.In certain embodiments, it is net negative less than conveyed base flow Inspiration trigger threshold value is changed into flow rate.For example, inspiration trigger threshold value can for -1.5LPM, -2LPM, -3LPM, - 4LPM, -5LPM, -6LPM, -7LPM and -8LPM flow rate change, or the scope that can change for flow rate, for example - 3LPM to -6LPM or -4LPM arrives -7LPM scope.This list is only exemplary and is not intended to be restricted.Lung ventilator Any proper flow speed that conveyed base flow can be will be less than during estimated detection trigger operates 212 changes tactile as air-breathing Send out threshold value.Because monitoring that exhalation flow not can determine that or unreliable, by estimated exhalation flow and known fixed base flow For example mathematically combine, to determine compared to the second net flow or second flow deviation of inspiration trigger threshold value.During exhalation It may indicate that patient just attempts air-breathing by a small amount of base flow decline for breathing out module.Base flow decline is attributable to gas and is redirected to trouble The lung of person (in response to slight negative pressure gradient).

In another embodiment, when patient is reached as lung ventilator in determination during estimated detection trigger operates 212 During stable exhalation part, the second trigger condition is met.In order to determine stable exhalation part, lung ventilator is grasped in estimated detection trigger The estimated exhalation flow of monitoring during making 212.In certain embodiments, during estimated detection trigger operation 212, lung ventilator Multiple exhalation flow estimations are collected within the setting cycle after being expired during breathing out in the restriction cycle.As used herein Limit the cycle as breathe out start when the predetermined period of time that starts.Patient is stopped in the predetermined period of time phase in restriction cycle Between trigger ventilation.For example, the restriction cycle can be for 25ms, 50ms, 100ms, 200ms and/or for preventing patient's triggering suction Any other suitable time cycle of gas.In one embodiment, lung ventilator passes through during estimated detection trigger operation 212 Each estimated exhalation flow for calculating circulation is monitored to determine stability.In certain embodiments, it is per 5ms to calculate circulation. If the difference between two continuous exhalation flow estimations is zero or close to zero, stable exhalation part and lung ventilator are had determined that Selection performs conveying operations 214.

In one embodiment, if breathing of the lung ventilator during exhalation is determined during estimated detection trigger operates 212 Machine and/or patient parameter are met and/or beyond inspiration trigger threshold value or the second trigger condition, then lung ventilator selection performs conveying behaviour Make 214.If lung ventilator and/or patient parameter of the lung ventilator during exhalation is determined during estimated detection trigger operates 212 And be unsatisfactory for and/or beyond inspiration trigger threshold value or the second trigger condition, then lung ventilator performs failure decision operation 206 again.

In one embodiment, lung ventilator through it is pre-configured with after predetermined exhalation time amount select perform conveying operations 214, to prevent patient from becoming hypoventilation.Therefore, predetermined exhalation time amount is that activation threshold value or second touch in this embodiment Clockwork spring part.For example, lung ventilator during estimated detection trigger operates 212 by exhalation at 20 seconds, 30 seconds or 60 seconds when Between after automatically select execution conveying operations 214.In certain embodiments, predetermined time amount can be inputted or by exhaling by clinician Suction machine is calculated.In certain embodiments, whether it by clinician and/or lung ventilator based on patient is baby that predetermined time amount is Youngster, children, adult, male, women and/or just determined by the specified disease patient's condition.

In addition, method 200 includes conveying operations 214.Lung ventilator is exhaled during conveying operations 214 to patient's conveying is next Inhale.Being transported to the breathing of patient can be determined by lung ventilator and/or patient parameter.For example, convey breathing and may be based on choosing Fixed type of respiration or ventilating mode, such as EBUV.After by respiratory delivery to patient, lung ventilator selection returns to monitoring behaviour Make 204.

Those skilled in the art will realize that the method and system of the present invention can be implemented in numerous ways, and therefore It is not only restricted to one exemplary embodiment above and example.In other words, performed by single or multiple component, with hardware and software or The function element that the various combination execution of firmware and discrete function are performed can be distributed in client level or server tier or this Among software application at two rank.In this, any number feature of not be the same as Example described herein It can be combined in single or multiple embodiment, and the alternative implementation having less than or more than whole features described herein Example is possible.Feature can also be currently known or will become known mode and completely or partially be distributed in multiple components to work as In.Therefore, various software/hardware/firmware combination may reach function described herein, feature, interface and preference.This Outside, the present invention cover for carrying out described feature and function and the known conventional mode of interface, and as by institute The technical staff in category field now and later it will be understood that hardware described herein or software fastener components can be made Those changes and modification.

Numerous other changes can be made, the change is readily able to be understood by those skilled in the art and be covered by this hair In bright spirit, and as defined in appended claims.Although describing various embodiments for purposes of the present invention, The various changes being within the scope of the present invention well and modification can be made.Numerous other changes can be made, the change will It is easy to be understood and be covered by the spirit of the present invention by those skilled in the art, and as defined in claims.

Claims

1. a kind of be used for the method that lung ventilator is patient ventilation, it includes：

The fixed base flow of conveying；

Monitoring exhalation flow, exhalation pressure and exhalation aux. pressure during being the patient ventilation with the lung ventilator, with true It is fixed to monitor exhalation flow, monitor exhalation pressure and monitor exhalation aux. pressure；

At least stop utilizing first trigger condition based on the exhalation flow；

Based on it is described monitor exhalation pressure and it is described monitor that breathing out aux. pressure estimates the exhalation flow, to determine Estimation exhalation flow；

2. according to the method described in claim 1, wherein second trigger condition is about the zero estimated exhalation stream The slope of amount.

3. according to the method described in claim 1, wherein second trigger condition be the estimated exhalation flow up to Zero slope is had decreased below after to about zero.

4. according to the method described in claim 1, wherein second trigger condition for violate activation threshold value based on described solid Determine the flow deviation of base flow and the estimated exhalation flow.

5. method according to claim 4, wherein the estimated exhalation stream that the activation threshold value is at least 1.5LPM Amount declines.

6. method according to claim 4, wherein the flow that the activation threshold value is -0.1LPM to -20LPM changes model Enclose.

7. according to the method described in claim 1, it further comprises：

It is being to monitor exhalation time during the patient carries out the ventilation with the lung ventilator；

The 3rd trigger condition is at least detected based on exhalation time is monitored；And

Detect the 3rd trigger condition in response to described and trigger air-breathing.

8. method according to claim 7, wherein the 3rd trigger condition is at least exhalation time of 20 seconds.

9. according to the method described in claim 1, wherein described be not present for monitoring exhalation flow is because from described Lung ventilator removes exhalation flow sensor.

10. according to the method described in claim 1, wherein described be not present for monitoring exhalation flow is due to exhalation stream There is failure in quantity sensor.

11. according to the method described in claim 1, it further comprises：

In response to it is described detect it is described monitor exhalation flow described in be not present, at least based on the estimated exhalation flow To determine estimated exhalation tidal volume；And

The display estimated exhalation tidal volume.

12. according to the method described in claim 1, it further comprises：

It is not present in response to described monitor described in exhalation flow：

Show at least one of the following：Breathe out the removed notice of flow sensor, exhalation flow sensor hair Notice, the estimated exhalation flow and second trigger condition of raw failure.

13. a kind of respirator system, it includes：

Pressure generating system, it produces the respiratory air flow for including fixed base flow；

Venting tubing system, it includes the patient interface for being used for that the pressure generating system to be connected to patient；

Exhalation valve, it is connected to the venting tubing system；

Multiple sensors, it is operatively coupled to the pressure generating system, the patient and the breather line system At least one of system, for monitoring pressure of inspiration(Pi), inspiratory flow, breathes out pressure, exhalation aux. pressure and exhalation flow, with It is determined that monitored pressure of inspiration(Pi), monitoring inspiratory flow, monitoring exhalation pressure, monitor that breathing out aux. pressure and monitoring exhales Outflow；

Flow estimation module is breathed out, the exhalation flow estimation module monitors that exhalation pressure and described monitor are exhaled based on described Go out aux. pressure to estimate the exhalation flow to determine estimated exhalation flow；

Driver, the driver controls the exhalation valve at least based at least one of the following with by ventilation delivery To the patient：It is described to monitor exhalation flow, and monitor that exhalation pressure and described monitor breathe out auxiliary pressure based on described The estimated exhalation flow that power is determined；

Main trigger module, the main trigger module triggers air-breathing based on the one for occurring at least one of following event：

At least exhalation flow detection is monitored to the first trigger condition based on described, and

Predetermined exhalation time amount expires；

Standby trigger module, the standby trigger module triggers institute based on the one for occurring at least one of following event State air-breathing：

At least based on the estimated exhalation flow detection to the second trigger condition, and

The predetermined exhalation time amount expires；

Controller, the controller determine it is described monitor that exhalation flow is not present, and be switched to institute from the main trigger module State standby trigger module.

14. respirator system according to claim 13, it further comprises：

Display, it shows at least one of the following：Breathe out the removed notice of flow sensor, the exhalation flow The notice of sensor failure, the estimated exhalation flow and second trigger condition.

15. respirator system according to claim 13, wherein the controller, which detects described monitor, breathes out flow It is described be not present because exhalation flow sensor be removed.

16. respirator system according to claim 13, wherein the controller, which detects described monitor, breathes out flow It is described be not present because exhalation flow sensor break down.

17. respirator system according to claim 13, it further comprises：

Display, it shows the estimated exhalation flow and estimated exhalation tidal volume, wherein the exhalation flow estimation mould Block is estimated to breathe out tidal volume based on the estimated exhalation flow.

18. respirator system according to claim 13, wherein second trigger condition is the pressure more than or equal to 1 Slope Counter Value.

19. respirator system according to claim 13, wherein base of second trigger condition for violation activation threshold value In the flow deviation of the fixed base flow and the estimated exhalation flow.

20. a kind of be used for the method that lung ventilator is patient ventilation, it includes：

Determine it is described monitor exhalation flow be not present；

It is not present in response to described monitor described in exhalation flow, at least monitors exhalation pressure and exhalation auxiliary based on described Pressure is to estimate the exhalation flow to determine estimated exhalation flow；And

In response to it is described monitor exhalation flow described in be not present, at least based on it is described monitor exhalation flow and stop convey The ventilation, and at least it is based on the estimated exhalation flow alternatively delivery of ventilation.